双侧面动脉穿支皮瓣在鼻中下部大面积缺损修复中的应用

Application of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose

目的 探讨双侧面动脉穿支皮瓣修复鼻中下部大面积缺损的可行性和疗效。方法 回顾分析2019年1月—2022年12月采用双侧面动脉穿支皮瓣修复的18例鼻中下部大面积缺损患者临床资料。其中男13例,女5例;年龄43~81岁,平均63岁。鼻部外伤3例,基底细胞癌4例,鳞癌8例,淋巴瘤1例,大面积日光性角化破溃2例。缺损范围3.0 cm×3.0 cm~4.5 cm×4.0 cm;单侧皮瓣切取范围3.0 cm×1.3 cm~3.5 cm×2.0 cm,皮瓣切取总范围为3.3 cm×2.6 cm~4.5 cm×4.0 cm。结果 术后1例患者出现皮瓣坏死,改行额部皮瓣修复创面;1例因皮瓣静脉淤血,拆除部分缝线后逐渐好转,创缘创面经换药后延期愈合;余16例双侧面动脉穿支皮瓣成活良好,创面均Ⅰ期愈合,未出现“猫耳”畸形。18例患者供区均Ⅰ期愈合,遗留线形瘢痕,无明显瘢痕增生,面部器官无牵拉移位。所有患者均获随访,随访时间3~12个月,平均6个月。因皮瓣厚度适宜,18例患者均未行二期皮瓣修薄手术。所有皮瓣血运好,质地、色泽与周围组织相近,双侧鼻唇沟对称,患者满意度较高。结论 双侧面动脉穿支皮瓣修复鼻中下部大面积缺损可获得良好外形和功能,操作相对简便,患者满意度高。

Objective To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose.Methods The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed.Among them,there were 13 males and 5 females,the age ranged from 43 to 81 years,with an average of 63 years.There were 3 cases of nasal trauma,4 cases of basal cell carcinoma,8 cases of squamous cell carcinoma,1 case of lymphoma,and 2 cases of large area solar keratosis.The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm;the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm,and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm.Results One patient developed skin flap necrosis after operation,and a frontal skin flap was used to repair the wound;1 case gradually improved after removing some sutures due to venous congestion in the skin flap,and the wound healing was delayed after dressing change;the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention,without any“cat ear”malformation.All 18 patients had first intention healing in the donor area,leaving linear scars without obvious scar hyperplasia,and no facial organ displacement.All patients were followed up 3-12 months,with an average of 6 months.Due to the appropriate thickness of the flap,none of the 18 patients underwent secondary flap thinning surgery.All flaps had good blood circulation,similar texture and color to surrounding tissues,symmetrical bilateral nasolabial sulcus,and high patient satisfaction.Conclusion The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function,and the operation is relatively simple,with high patient satisfaction.